“Medicaid Waiver” What is it? Do I qualify? How do I get started?

Posted on August 14, 2018 by lawp873

The name waiver comes from the fact that the federal government “waives” Medical Assistance/Medicaid rules for institutional care in order for Pennsylvania to use the same funds to provide supports and services for people closer to home in their own communities.

When trying to pay for senior home care the Aging Waiver is where a lot of people focus. The Aging Waiver is designed to help people who are age 60 and older who have been assessed and require services at the level of nursing facility care, needing assistance with activities of daily living (ADL’s) and have a financial need. If an individual qualifies physically and financially the Aging Waiver provides funds to pay for in-home care.

In Pennsylvania, the Department of Human Services administers multiple Medical Assistance/Medicaid waivers. Each waiver has its own unique set of eligibility requirements and services.

Waivers offer an array of services and benefits such as choice of qualified providers, due process, and health and safety assurances.

Currently, Pennsylvania has many waiver programs that are designed for specific needs including:

Aging Waiver
Attendant Care Waiver
Independence Waiver
OBRA Waiver
Act 150 Waiver

The First Step:

The first step in applying for the Aging Waiver is to contact Pennsylvania’s Independent Broker (PA IEB)

The IEB will provide the path you need to follow to determine financial eligibility and physical eligibility. If you qualify the IEB will provide you a list service coordinators you will choose from and they will provide you with a list of home care agencies to choose from. Then you can begin home care. The Team is made up of three parts: you, the client, the Service Coordinator and the Home Care Agency. You the client have the ongoing option to change and choose different Service Coordinator and Agency to best fit your needs. For example, if you are working with an agency that you are not happy with you can switch to Loving Arms Elder Care who is an approved Aging Waiver provider.

A decision about whether you qualify will be sent to you within 90 days after PA IEB starts your waiver application. If you do not get a decision within 90 days, you can ask for a fair hearing.

Senior Home Care Agency or Registry?

Originally Posted on August 31, 2018 by lawp873

The thought of senior home care can be daunting. Many families are thrust into the home care maze when a loved one has an unexpected fall or surgery. Suddenly, important decisions need to made very quickly. This post will help to streamline the options and help families make informed decisions about senior home care.

Essentially there are three different options to consider:

The agency model (Loving Arms Elder Care)
The registry model (Home Care Connect, or Care.com)
Private hiring

Agencies make things easy. They have a pre-screened staff of trained caregivers. They can usually begin care at a moment’s notice and they handle all the things you are not even thinking about like payroll, insurances, and scheduling. When choosing an agency look for length of time in business, fees and the process they use to match clients and caregivers. This service comes at a premium though. Agencies may not be an affordable option for every family.

The registry model can be more economical than an agency. You will most likely save 25% or more when compared with typical agency fees, but the savings comes from your willingness to do some of the work on your own. Registries offer lists of caregivers in your area. It is usually your job to contact, interview and set up the care schedule. You may need to do some in-home training and make plans for the eventual call-out situation. Many registry sites offer safety net services like background screenings and complete payroll services. Much of this work can be completed online and can be shared with different family members. When using a registry, look for companies that offer local representatives that can guide you through the process.

Private hire is very prevalent but is the model that requires the most work. It can begin innocently, a nice woman from church agrees to care for your mother in her home. But have you considered things like: work eligibility, background checks, references, drug testing, payroll taxes and liability insurance? (Bartelstone,2018) Private hire works wonderfully until it doesn’t. What if the care suddenly increases? What if someone gets hurt? What if your caregiver suddenly finds themselves out of a job and they file for unemployment? These are real concerns that can end up costing much more than you are saving. Consider consulting a local elder law attorney for advice before hiring privately.

It’s a lot to consider. How can you possibly make the best decision for your family? First, have the conversation before you are forced to have it. Ask questions about what in-home care might look like. Find out how will you pay for the care. Is there a long-term care policy? If so take a look at it, understand what your options are. You are not alone. There are many professionals in your local community who are ready and willing to help. “Professionals including social workers, care managers, nurses and those at community agencies working together will ensure that the burdens of receiving care don’t compound the existing challenges faced by the family.”(Bartelstone 2018)

Bartelstone, Rona. (2018). Case In Point: Hiring In-home Caregivers. CSA Journal,70(1),68Bartelstone, Rona. (2018). Case In Point: Hiring In-home Caregivers. CSA Journal,70(1),70
CSA Journal
Alice Jacobs, CSA
Loving Arms Elder Care / Home Care Connect

Long Term Care insurance policy…now what?

Originally Posted on November 7, 2017 by lawp873

Long-Term Care Insurance

Long-Term Care (LTC) insurance is one option many people choose to provide financial protection when they begin to need help with the activities of daily living. LTC insurance coverage in Pennsylvania provides services in your home, a medical facility or a combination of the two.

Make contact with the insurance company and get the following information:

Policy Number: You will need this along with a claim number to reference all correspondence with the insurance company.
Find out whether or not home care is covered: Some of the older policies only covered care in a facility.
Elimination Period: This is like a deductible. It is the number of days the individual must pay out of pocket for covered services before the insurance company will begin to make payments, usually 30, 60 or 90 days. Some policies use calendar days and others use days of care. This is a very important distinction. For example, 90 calendar days could mean that you pay for care 2 days a week for 3 months (90 days), essentially paying out of pocket for 24 days of care to satisfy the 90 day elimination period. 90 days of care, on the other hand, would mean paying for 90 actual days of care, 90 days in a row or 90 days of care spread out, say 2 days a week for 45 weeks. As illustrated there is a big difference between the two.
Benefit Amount: The amount of insurance benefits that a policy will pay per day for covered Long-Term Care expenses. This can have stipulations as a maximum per day or a maximum pool of money.
Benefit Period: The length of time a policy will pay a benefit. Common time frames are 1 year, 5 year, Lifetime. Sometimes the period can be until a maximum pool of money is exhausted.
• Inflation Rider: Some policies have a rider that will increase the benefit amount over time using simple or compound interest. Simple vs. compound can make a very big difference.
Benefit Triggers: Activities of daily living and cognitive impairment levels that trigger the need for Long-Term Care. Activities of Daily Living (ADLS) are activities that measure a person’s level of dependence. Activities could include bathing, continence, dressing, eating, toileting and transferring (mobility). The policy will pay benefits if you are unable to perform a specified number of ADLs, usually 2 or 3, and/or having cognitive impairment issues.

All of the above information should be included in the policy itself. If you do not have the physical policy please ask the insurance company for a copy. Always a good practice.

After you have this information notify the insurance company what home care agency you will be working with or if you will be working with a consumer directed private caregiver. The insurance company will request a copy of the agency license or a copy of the individual caregiver’s credentials. The insurance company will also want a copy of the plan of care. Please be advised you are not locked into any one provider, you can change as your needs and wants change, keep the insurance company informed.

After the claim is approved the insurance company will require copies of care notes, paid invoices and any care plan changes on an ongoing basis, usually by fax.

All of this can be a little overwhelming, some people hire an independent Geriatric Care Manager to help and advocate and process the claim. Some home care agencies will provide the same help and advocacy and process as well.

Here is a link to the Aging Life Care Association where you can find a Geriatric Care Manager.

Additional Resources:
Pennsylvania Insurance Department, Long Term Care
Administration on Aging

Please keep in mind that all policies are a little different and this information is a general framework.

VA Pension Benefit Basics

Originally Posted on September 28, 2017 by lawp873

VA Pension Benefit

VA Pension Benefit is a supplemental income benefit for veterans, spouses and/or their surviving spouses. The VA helps Veterans and their families cope with financial challenges by providing supplemental income through the Veterans Pension benefit. Veterans Pension is a tax-free monetary benefit payable to low-income wartime Veterans.

The Pension has three levels:
• Pension: over age 65
• Pension with Housebound benefit: disabled and confined to the home
• Pension with Aid & Attendance benefit: disabled and require the aid of another person to assist with activities of daily living or cognitive impairment.

The monthly benefits range from $721 to $2846, as of 2017 increase. Click here for current rates.

To qualify:
65 or older, at least 90 days of service, at least 1 day during active war time, discharge other than dishonorable, financially qualify.

To apply as a veteran you need VA form 21P-527 or 21P-527EZ.
To apply as a survivor you need VA form 21P-534 or 21P-534EZ

The application process can be intimidating and complex. It is recommended that you work with a VSO (Veteran Service Organization) or a financial professional to complete the application. This should be a free service as it is illegal to charge a fee to assist in the completion of any VA benefit form or paperwork.

The pension benefit can be used to pay for a caregiver that can help a veteran and /or spouse with getting dressed, preparing meals, food shopping, driving to a doctors’s appointment, light house cleaning, laundry, bathing, companionship, etc.

Matt Read